<h1>Request Group Rate</h1>
<form>
    <input type="hidden" name="referrer">
    <label for="filed-name">
        Name: <input type="text" id="filed-name" name="name"><br>
    </label>
    <label for="group-size">
        Group size: <input type="text" id="group-size" name="groupSize">
    </label>
    <label for="email">
        Email: <input type="email" name="email">
    </label>
    <input type="submit" value="Submit">
</form>
<script>
    $(document).ready(function () {
        $('input[name="referrer"]').val(document.referrer);
    })
</script>